Does your child have any allergies? What are the symptoms and actions to be taken, if any? *

Physician's Name *

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Last

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Physician's Phone Number *

Insurance Company *

Policy Number *

Hospital Preference *

Photo Authorization *

I consent to TechSmart Academy’s use of any photos or videos that are taken of my child while participating at camp activities for use on TechSmart Academy’s website, and marketing material that may be distributed as a printed document or published on the internet. I understand that neither I nor my child will be compensated for this.